The present application is generally directed to medical devices, systems, and methods. In a particular embodiment, the invention provides telesurgical robotic tools, systems and methods.
Advances in minimally invasive surgical technology could dramatically increase the number of surgeries performed in a minimally invasive manner. Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. The average length of a hospital stay for a standard surgery may also be shortened significantly using minimally invasive surgical techniques. Thus, an increased adoption of minimally invasive techniques could save millions of hospital days, and millions of dollars annually in hospital residency costs alone. Patient recovery times, patient discomfort, surgical side effects, and time away from work may also be reduced with minimally invasive surgery.
The most common form of minimally invasive surgery may be endoscopy. Probably the most common form of endoscopy is laparoscopy, which is minimally invasive inspection and surgery inside the abdominal cavity. In standard laparoscopic surgery, a patient""s abdomen is insufflated with gas, and cannula sleeves are passed through small (approximately xc2xd inch) incisions to provide entry ports for laparoscopic surgical instruments. The laparoscopic surgical instruments generally include a laparoscope (for viewing the surgical field) and working tools. The working tools are similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an extension tube. As used herein, the term xe2x80x9cend effectorxe2x80x9d means the actual working part of the surgical instrument and can include clamps, graspers, scissors, staplers, and needle holders, for example. To perform surgical procedures, the surgeon passes these working tools or instruments through the cannula sleeves to an internal surgical site and manipulates them from outside the abdomen. The surgeon monitors the procedure by means of a monitor that displays an image of the surgical site taken from the laparoscope. Similar endoscopic techniques are employed in, e.g., arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cistemoscopy, sinoscopy, hysteroscopy, urethroscopy and the like.
There are many disadvantages relating to current minimally invasive surgical (MIS) technology. For example, existing MIS instruments deny the surgeon the flexibility of tool placement found in open surgery. Most current laparoscopic tools have rigid shafts, so that it can be difficult to approach the worksite through the small incision. Additionally, the length and construction of many endoscopic instruments reduces the surgeon""s ability to feel forces exerted by tissues and organs on the end effector of the associated tool. The lack of dexterity and sensitivity of endoscopic tools is a major impediment to the expansion of minimally invasive surgery.
Minimally invasive telesurgical robotic systems are being developed to increase a surgeon""s dexterity when working within an internal surgical site, as well as to allow a surgeon to operate on a patient from a remote location. In a telesurgery system, the surgeon is often provided with an image of the surgical site at a computer workstation. While viewing a three-dimensional image of the surgical site on a suitable viewer or display, the surgeon performs the surgical procedures on the patient by manipulating master input or control devices of the workstation. The master controls the motion of a servomechanically operated surgical instrument. During the surgical procedure, the telesurgical system can provide mechanical actuation and control of a variety of surgical instruments or tools having end effectors such as, e.g., tissue graspers, needle drivers, or the like, that perform various functions for the surgeon, e.g., holding or driving a needle, grasping a blood vessel, or dissecting tissue, or the like, in response to manipulation of the master control devices.
At the working end of the robotic surgical instrument, a wrist-like mechanism may be provided between an end of the shaft and the end effector. The wrist-like mechanism enables the position or orientation of the end effector to be varied relative to the end of the shaft. The wrist-like mechanism may also be operatively connected to the master controls to enable the position or orientation of the end effectors to be varied by the surgeon manipulating the master controls.
It is to be appreciated that such a telesurgery system described above typically includes two robotic arms. Each arm typically carries a surgical instrument. Two master controls are typically provided, each of which is in operative communication with one of the arm and instrument systems, the master controls being arranged to be gripped in respectively the right and left hands of the surgeon.
It is an object of this invention to provide improved robotic surgical tools, devices, and methods. In one embodiment, the invention provides an improved wrist-like mechanism for use in a telesurgery system as described above. It is further an object of this invention to provide specific end effectors for use in conjunction with such a wrist-like mechanism.
In accordance with one aspect of the invention, a minimally invasive surgical instrument including an elongate shaft having a working end is provided. A wrist member having an end portion is pivotally mounted on the working end of the preferably substantially rigid shaft at its end portion by means of a pivotal connection. At least one end effector mounting formation is pivotally mounted by means of a pivotal connection on an opposed end portion of the wrist member. An elongate element length extends from each of two opposed positions on the end effector mounting formation and in a direction toward an opposed end of the shaft. The elongate element lengths are coupled to a driving member so as to cause angular displacement of the end effector mounting formation in one angular direction in response to the driving member causing one of the elongate element lengths to be pulled and to cause angular displacement of the end effector mounting formation in an opposed angular direction in response to the driving member causing the other elongate element length to be pulled. An elongate element length also extends from each of two opposed positions on the wrist member and in a direction toward the opposed end of the shaft, these elongate element lengths are coupled to another driving member so as to cause the wrist member to pivot about its pivotal connection in one angular direction in response to that driving member causing one of the elongate element lengths to be pulled and to cause the wrist member to pivot in an opposed angular direction in response to that driving member causing the other elongate element length to be pulled.
The minimally invasive surgical instrument may further include another end effector mounting formation and an elongate element length extending from each of two opposed positions on that end effector mounting formation and in a direction toward the opposed end of the shaft. These elongate element lengths may be coupled to yet a further driving member so as to cause the further end effector mounting formation to displace in one angular direction in response to the further driving member causing one of the elongate element lengths to be pulled and to displace in an opposed angular direction in response to the further driving member causing the other elongate element length to be pulled.
According to another aspect, a minimally invasive surgical instrument is provided which includes, a pair of end effector mounting formations each of which is arranged to carry an end effector element and to be displaceable so that the end effector elements move toward and away from each other in a plane of movement. The minimally invasive surgical instrument may further include an urging arrangement arranged to urge the end effector elements toward each other when they are moved apart beyond a predetermined amount. The urging arrangement may include a resilient urging member arranged to cooperate with the mounting formations so as to be resiliently deformed upon movement of the end effector elements beyond the predetermined amount thereby to urge the end effector elements toward each other. The resilient urging member may extend at an angle relative to the plane of movement.
According to a further aspect, a minimally invasive surgical instrument is provided which includes a pair of end effector mounting formations each of which is arranged to carry an end effector element and to be displaceable so that the end effector elements move toward and away from each other in a plane of movement. The minimally invasive surgical instrument may include an urging arrangement arranged to urge the end effector elements toward each other when they are moved apart beyond a predetermined amount. The urging arrangement may include at least one elongate resilient urging member one end of which is anchored on one of the mounting formations and an opposed free end of which intrudes into a space defined by the other mounting formation. The free end may be arranged to abut part of the other mounting formation defined at an end of the space when the end effector elements are moved apart by the predetermined amount, such that the resilient member is resiliently deformed by that part of the other mounting formation in response to the end effector elements being urged apart beyond the predetermined amount, thereby to urge the end effector elements toward each other.
According to yet another aspect, a minimally invasive surgical instrument is provided which includes a pair of end effector mounting formations each of which is arranged to carry an end effector element and to be displaceable so that the end effector elements move toward and away from each other in a plane of movement. The instrument may include an urging arrangement arranged to urge the end effector elements toward each other when they are moved apart beyond a predetermined amount. The urging arrangement may include at least one resilient member, the resilient member being made from a nickel and titanium alloy.
According to a further aspect, a minimally invasive surgical instrument is provided which includes a pair of blade members arranged to be displaceable against each other to perform a cutting action. The instrument may further include at least one mechanical urging member for urging at least one blade against the other whilst the blades perform the cutting action.
The blade members may be connected together about a common pivotal connection. The mechanical urging member may include at least one resilient urging member extending from the pivotal connection to a position against one of the blade members, at which position the urging member urges that blade member in a lateral direction against the other blade member.
According to yet another aspect, a minimally invasive surgical instrument is provided which includes an elongate shaft defining a working end. It may further include a wrist member, one end of which is pivotally mounted on the working end of the shaft by means of a pivotal connection to enable the wrist member to pivot about the pivotal connection. At least one remote actuator operatively connected to the wrist member may be provided to cause the wrist member to pivot in response to actuation of the actuator. It may further include an end effector mounting formation on an opposed end of the wrist member. The end effector mounting formation may be arranged removably to hold an end effector.
According to yet a further aspect, a minimally invasive surgical instrument is provided which includes a pair of end effector elements defining free ends arranged to be displaceable toward and away from each other in a plane of movement. At least one of the end effector elements may converge toward the other in a direction in the plane of movement such that when the free ends abut a space extends between the end effector elements and inwardly of their abutting free ends. At least one of the end effector elements may be of a resilient material so that upon the application of increasing force urging the end effector elements toward each other whilst their free ends abut, the resilient end effector element is caused to deform resiliently so as to decrease a size of the space.
According to yet another aspect, a minimally invasive surgical instrument is provided which includes an elongate shaft defining a working end and an electrode mounting formation on which an electrode is mounted or removably mountable. An electrical conductor may be electrically connected to the electrode mounting formation. The conductor may extend from the electrode mounting formation in a direction toward an opposed end of the shaft. A wrist member one end of which is pivotally mounted, by means of a pivotal connection, on the working end of the shaft so as to enable angular displacement of the wrist member about the pivotal connection may further be provided. The electrode mounting formation may be positioned at an opposed end of the wrist member. The wrist member may be of an electrically insulative material.
According to yet a further aspect, a minimally invasive surgical instrument is provided which includes an elongate shaft defining a working end. It may further include an electrode mounting formation on which an electrode is mounted or removably mountable. An electrical conductor may be electrically connected to the electrode mounting formation. The conductor may extend from the electrode mounting formation in a direction toward an opposed end of the shaft. A wrist member may be provided, the wrist member having one end pivotally mounted, by means of a pivotal connection, on the working end of the shaft so as to enable angular displacement of the wrist member about the pivotal connection. The electrode mounting formation may be positioned at an opposed end of the wrist member. At least one elongate element may be operatively connected to the wrist member to cause angular displacement of the wrist member about the pivotal connection in response to pulling the elongate element. The elongate element may extend from the wrist member toward the opposed end of the shaft. The elongate element may be at least partially of an electrical insulative material.
According to another aspect, an end effector arrangement of a minimally invasive surgical instrument is provided which includes a pulley portion. A channel formation may extend at least partially circumferentially around the pulley portion. The channel formation may define opposed flange formations. One of the flange formations may have a diameter less than the other.
According to a farther aspect, a minimally invasive surgical instrument is provided which includes a shaft having a working end. It may further include a wrist member mounted on the working end of the shaft. The wrist member may be arranged to have at least one degree of freedom of movement. At least one elongate element operatively connected to the wrist member to cause movement of the wrist member in response to pulling of the elongate element may be provided. The elongate element may have a relatively bendable portion in a region of the wrist member, and a relatively rigid portion in a region of the shaft.
According to yet a further aspect, a minimally invasive surgical instrument is provided which includes a shaft having a working end. An end effector mounting formation may be positioned at the working end of the shaft. It may be arranged to be angularly displaceable about at least two axes. Elongate elements may be connected to the end effector mounting formation to cause selective pivotal movement of the end effector mounting formation about the axes in response to selective pulling of the elongate elements. A support base may be positioned on an opposed end of the shaft. At least three spools may be angularly displaceably mounted on the support base. Opposed ends of the elongate elements may be connected to the spools so that selective angular displacement of the spools causes the selective pulling of the elongate elements. The spools may have axes that are parallel and spaced apart relative to each other.
The support base may include a generally planar outer surface and the axes may be generally perpendicular relative to the generally planar surface.